Women in medicine : impacts on specialties and settings of practice in North Carolina

WORKING PAPER SERIES

UNC-CH HEALTH SCIENCES LIBRARY

H00097077

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WOMEN IN MEDICINE:
IMPACTS ON SPECIALTIES AND SETTINGS
OF PRACTICE IN NORTH CAROLINA

UNIVERSITY OF NORTH CAROLINA

SOCIAL RESEARCH SECTION

DIVISION OF HEALTH AFFAIRS

THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

WOMEN IN MEDICINE:
IMPACTS ON SPECIALTIES AND SETTINGS
OF PRACTICE IN NORTH CAROLINA

UNIVERSITY OP NORTH CAROLINA

OCT 5 1981

HEALTH SCIENCES LIBRARY

Social Research Section

Harvey L. Smith, Ph.D., Director

Report: Maxine Springer Stern, Ph.D.

Division of Health Affairs
University of North Carolina at Chapel Hill
October, 1975

'

In the United States, the proportion of women physicians has historically
been small. In 1967, only seven percent of the physicians were women. A
survey undertaken by the Department of Health, Education and Welfare in 1962
cited the following obstacles to becoming physicians which were encountered
by women: job is too demanding to combine with family responsibilities; the
likelihood of part time employment is doubtful; parents actively discourage

daughters; men in the field resent women colleagues; restricts chances for

2
marriage.

In spite of the above reasons the percent of women who applied to and

were accepted by medical schools slowly increased from four percent in 1914

to nine percent in 1969. However, more recently, accompanying the emphasis

on equal opportunities for women and minority groups, and an increase in

women's desires to pursue careers, the proportion of women attending medical

schools has increased dramatically. In 1972, 16.8 percent of all entering

3
medical students in the United States were women. The figures presented

in Table 1 show a substantial increase in both the number and proportion of

women attending one medical school, the School of Medicine at the University

of North Carolina at Chapel Hill, for the years 1971 through 1974. These

figures represent a situation that is probably typical of other medical

schools .

The settings of medical practice and the primary specialties of physicians

greatly influence the medical care that is available to the people living in a

particular area. If female and male physicians tend to have different types

of medical careers, the changes in proportions of women and men who are being

trained as physicians may have important implications not only for the

structure of the medical profession, but also for the availability of medical

care. This study is a comparison of the types of medical careers of female

Table 1: Number of Male and Female Medical Students at the School of

Medicine, University of North Carolina at Chapel Hill for the
Years 1971 through 1974, by Class.*

Number

Fall 1974

Percent
Males Females Female

1st year, ECU* 17 3 15

1st year 85 26 23

2nd year 106 25 19

3rd year 98 28 22

4th year 95 11 10

Fall 1973

1st year, ECU* 18 2 10

1st year 88 23 21

18

2

88

23

01

30

07

11

88

12

2nd year 101 30 23

3rd year 97 11 10

4th year 88 12 12

Fall 1972

1st year, ECU* 20 0 0

1st year 84 28 25

2nd year 98 10 9

3rd year 91 10 11

4th vear 80 6 7

Fall 1971

1st year 98 13 12

2nd year 88 11 11

98

13

88

11

77

7

67

3

3rd year 77 7 8

4th year 67 3 4

*Since 1972 East Carolina University has had a first vear class of
medical students. They transferred to the Chapel Hill campus for the
remainder of their medical training. This procedure is no longer in effect,

Source: Registrar, UNC School of Medicine, Chapel Hill.

Digitized by the Internet Archive

in 2011 with funding from

North Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project

http://www.archive.org/details/womeninmedicineiOOster

4
and male physicians in North Carolina in 1973.

The main question addressed in this research is whether female physicians
have different medical careers, in terms of primary specialty and the setting
of practice, from male physicians. In addition, the differences in career
patterns between the younger female and male physicians and their older
counterparts will be explored.

The age of a physician indicates the period at which practice was begun.
The choice of a medical specialty is assumed to remain constant over a
physician's lifetime. Therefore, age is important not as an indicator of
what a physicians at a particular time in the life cycle does, but what
particular cohorts of physicians have done. Age will be used as an indicator
of trends and changes in specialty patterns and can be used to make projections
or speculations of how the medical profession may look at a future time. The
choice of a practice setting, however, may not be as stable. Differences
between younger and older physicians may reflect past and future trends in
practice settings; yet thev may simplv reflect stages in career patterns.
Age Distributions of Female and Male Physicians

The age distributions of female and male physicians are verv similar.
(See Table 2) However, one should note that the youngest category of female
physicians includes 17.1 percent of the women, while the youngest category
of male physicians includes 11.5 percent of the men. If the medical schools
continue to educate greater numbers of female physicians, while decreasing
the number of males, we can expect the number of female physicians in North
Carolina to increase and the proportion of female physicians in the younger
age groups to increase further.

Table 2: Age of Non-Federal Physicians in North Carolina, 1973, by Sex,
In Percentages

Age

Under 30
30 - 34
35 - 44
45 - 54
55 - 64
65+
Total

Fema

le

Number

Percent

64

17.1

48

12.8

79

21.1

75

20.0

69

18.4

40

10.7

Male

375

100.0

Number

686

779

1550

1414

839

720

5988

Percent
11.5
13.0
25.9
23.6
14.0
12.0
100.0

The percent of female physicians in each age category is presented in
Table 3. The youngest age category, under 30, has the highest percent of
women. This is a result of the recent increase in women attending medical
school.
Medical Specialties

The most common medical specialties are: general practice, internal
medicine, obstetrics and gynecologv, psychiatry, pediatrics and surgery.
Sixty-five percent of the women and 72.5 percent of the men specialize in
these areas of medicine. Pediatric specialties are pursued by approximately
one quarter of the female physicians. No other specialty is as frequent among
female physicians. The most frequent male specialties are surgery and general
practice, followed closely by internal medicine. The surgical specialties
are dominated by men. Almost one-fifth of the men (19.4 percent) list a
surgical field as their primary specialty, while only 2.1 percent of the
female physicians do likewise. (See Table 4 and Figure 1.)

Table 3: Percent of Non-Federal Physicians Who Are Women in North
Carolina, 1973, By Age.

Under 30
30 - 34
35 - 44
45 - 54
55 - 64
65+

Total 6.2 6363

Percent

Total

Female

Number

9.3

750

6.1

827

5.1

1629

5.3

1489

8.2

908

5.5

760

Table 4 : Primary Specialty of Non-Federal Physicians in North Carolina,
1973, By Sex, In Percentages.

Male Female

allergy 0.3 0.5

aerospace 0.1 0.0

anesthesiology 1.8 5.1

cardiology 1.8 0.5

child psychiatry 0.6 2.7

colon-rectal surgery 0.2 0.0

dermatology 1.3 1.1

diagnostic radiology 0.8 0.3

forensic pathology 0.0 0.0

gastroenterology 0.5 0.3

general practice 18.4 10.1

general preventive medicine 0.2 1.3

general surgery 11.1 1.3

internal medicine 15.1 10.1

neurology 1.1 0.8

neurosurgery 0.9 0.0

obstetrics and gynecology 7.4 6.1

occupational medicine 0.8 0.3

ophthalmology 3.4 0.5

orthopedic surgery 3.5 0.5

otolaryngology 1.8 0.5

psychiatry 5.5 9.6

pediatrics 5.9 24.0

pediatric allergy 0.1 0.3

pediatric cardiology 0.2 0.0

public health 1.5 5.9

physical rehabilitation 0.1 0.0

plastic surgery 0.6 0.3

pathology 3.4 4.9

pulmonary diseases 0.8 1.3

radiology 3.7 0.8

therapeutic radiology 0.4 0.3

thoracic surgery 0.5 0.0

urological surgery 2.6 0.0

other specialties 2.4 5.1

unspecified 1.5 4.5

100.0 100.0

(5988) (375)

Figure 1: Percentage of Female and Male Physicians, by Primary Specialty 1973

30

20

10

women

men

GP General Practice

IM Internal Medicine

OBG Obstetrics-Gynecology

PSY Psychiatry, Child Psychiatry

PED Pediatrics, Pediatric Allergy

Pediatric Cardiology

SUR Surgical Specialties

OTH All Other Specialties

UN Unspecified

Women physicians are 5.89 percent of the total number of non-federal
physicians in North Carolina. To illustrate the effect of the change in
the proportion of female physicians, we have projected what the distribution
of primary specialties would look like, if women were 20 percent of the
physicians manpower force and men were 80 percent. A comparison of the
distribution of primary specialties of all (male and female) North Carolina
physicians with the projected distribution, weighted for the changes in the
proportions in each group, presented in Figure 2, illustrates that the effect
of the male/female ratio on the distribution of primary specialties may not
be great.

The proportions of general practitioners, internists, obstetrician-
gynecologists, and surgeons would slightly lower, while the proportions of
psychiatrists and pediatricisns would be slightly higher. It does not
seem, however, that increased number of women in medicine would in any
important way alter the overall presence of specialists in the State.

Tables 5 and 6 suggest, however, that younger male and female physicians
are not following in the primary specialty areas of their elders. As an
indication of the specialties of younger physicians, we have noted that
the specialty distribution of male and female physicians under 35 and compared
these with the distributions of all male and all female physicians in 1973.
(See Table 7.)

In many ways, the younger male and female groups are more similar to
each other than the younger and total groups for each sex. While it is
true that increasing proportions of younger women are becoming pediatricians
and increasing proportions of younger men are becoming surgeons, younger men
and women are less likely than older physicians to become general
practitioners and obstetricians and more likely to specialize in internal

Figure 2: Percentage of all Physicians, 1973, by Primary Specialty and Projected percentage
distribution of Physicians if Women Physicians were 20% and Male Physicians were
80% of the Physician Manpower Force.

30

20

10

17.9

GP

26.22^8

VVl^ 7.3 7 1 K4 7.3 7.3 |X ^V^^ VS^

VvK J\>%J X^V sVW V^J V\K

1 I1II1a_

IM

1973

OBG

PSY PED

SUR

OTH

UN

projected

GP General Practice

IM Internal Medicine

OBG Obstetrics-Gynecology

PSY Psychiatry, Child Psychiatry

PED Pediatrics, Pediatric Allergy

Pediatric Cardiology

SUR Surgical Specialties

OTH All Other Specialties

UN Unspecified

10

Table 5: Age and Primarv Specialty of Female Non-Federal Physicians in North
Carolina, 1973, In percentages.

Total

under 30

4.7

18.8

3.1

10.9

31.3

0

14.1

17.2

100.0

(64)

30-34

6.3

12.5

2.1

16.7

22.9

2.1

33.3

4.2

100.0

(48)

35-44

8.9

5.1

2.5

16.5

35.4

1.3

30.4

0

100.0

(79)

45-54

12.0

8.0

5.3

12.0

22.7

6.7

29.3

4.0

100.0

(75)

55-64

11.6

5.8

14.5

8.7

15.9

1.4

40.6

1.4

100.0

(69)

65+

20.0

15.0

10.0

7.5

10.0

0

37.5

0

100.0

(40)

Total

10.1

10.1

6.1

12.3

24.4

2.1

30.4

4.5

100.0

(375)

1 general practice

2 internal medicine

3 obstetrics-gynecology

4 psychiatry, child psychiatry

5 pediatrics, pediatric allergy, pediatric cardiology

6 surgical specialties

7 all other specialties

8 unspecified

11

Table 6: Age and Primary Specialty of Male Non-Federal Physicians in North
Carolina, 1973, in percentages.

age 1 2 3 4 5 6 7 8 Total N

under 30 5.1 29.3 6.0 7.3 11.1 18.7 13.8 8.7 100.0 (686)

30-34 5.4 17.7 5.8 6.2 6.5 25.2 32.1 1.2 100.0 (779)

35-44 14.7 13.3 9.7 7.4 6.4 19.9 28.3 0.3 100.0 (1550)

45-54 24.6 13.5 7.5 6.3 6.6 18.2 22.8 0.4 100.0 (1414)

55-64 26.5 12.2 7.3 4.4 3.9 19.5 25.5 0.7 100.0 (839)

65+ 31.5 9.2 5.4 3.2 2.9 15.0 32.1 0.7 100.0 (720)

Total 18.4 15.1 7.4 6.0 6.2 19.5 25.9 1.5 100.0 (5988)

1 general practice

2 internal medicine

3 obstetrics-gynecology

4 psychiatry, child psychiatry

5 pediatrics, pediatric allergy, pediatric cardiology

6 surgical specialties

7 all other specialties

8 unspecified

:

12

Table 7: Primary Specialties of Female and Male Physicians under 35 and All
Female and Male Physicians, 1973

Specialties

General Practice
Internal Medicine
Obstetrics-Gynecology
Psychiatry & Child Psychiatry
Pediatric Specialties
Surgical Specialties
All Others
Unspecified

Total

N

Under

35

All

Female

%

Male

%

5.3

Female

%

Male

%

5.3

10.1

18.4

16.1

23.1

10.1

15.1

2.7

5.9

6.1

7.4

13.4

6.7

12.3

6.0

27.7

8.7

24.3

6.2

0.9

22. 1

2.1

19.2

22.3

23.5

30.4

25.9

11.6

4.7

4.5

1.5

100.0

100.0

100.0

100.0

(112)

(1465)

(375)

(5988)

r

13

medicine. To illustrate the effects of both age and the proportional changes
of male and female physicians, the distribution of primary specialties has
been projected for two hypothetical situations in addition to the projected
distribution discussed above:

1. if all physicians were like those under 35;

2. if all physicians were like those under 35, and if 20 percent
of all physicians were women and 80 percent male.

Figure 3 leads us to conclude that the current trends in medical
specialization may have a considerable effect on the future patterning of
specialties, while the changes in the proportion of men and women in
medicine may have a minimal effect.

It should be emphasized that these projections are not exact predictions
of the future distributions of primary specialties. They are only heuristic
devices which give us a picture of what would happen if physicians continued
to change in the direction of the current trends. It may be unlikely that
the current trends of specialization will remain stable over the next 30
or 40 years. However, the comparisons and projections focus attention on
the direction of current changes.
Setting of Medical Practice

The greatest differences in the setting of medical practice of men and
women physicians is that men are more likely than women to have office-based
practices, while women are more likely to have hospital- based practices,
to be in "other" types of practices, or to be inactive. (See Table 8.)

To see the effect of the changes in the male/female physicians ratio,
we have projected the distribution of medical practice settings physicians
would have if 20 percent of the physicians were women and 80 percent were
men. Because residents and interns have not yet established practices,

Figure 3: Distribution of Physicians 1973 and Projected Distributions, by Primary Specialty

30

20

10

UN

1973 distribution

projected distribution, if 20% women, 80% men

projected distribution, if all physicians were like those under 35

projected distribution, if women were 20%, men 80% and all physicians were like those under 35

GP General Practice

IM Internal Medicine

OBG Obstetrics-Gynecology

PSY Psychiatry, Child Psychiatry

PED Pediatrics, Pediatric Allergy

Pediatric Cardiology

SUR Surgical Specialties

OTH All Other Specialties

UN Unspecified

f

15

Table 8: Setting of Medical Practice of Non-Federal Physicians in North
Carolina, 1973, By Sex, In Percentages.

Setting of Practice

Office-based

Hospital -based

Resident

Intern

Research

Medical Teaching

Administration

Other

Inactive

Not classified

Total

Female

44.5

8.0

12.6

3.6

2.9

2.9

5.9

1.3

12.0

4.0

100.0
(5988)

Male
62.0
3.8
13.9
4.5
2.8
1.8
3.4
0.6
5.7
3.8

100.0
(375)

16

they are omitted from these figures. (See Figure 4.) As with the distribution
of primary specialties, the effect of the changes in the sex ratio in the
profession of medicine would have a minimal effect on the distribution of
the settings of medical practice.

The setting of medical practice is likely to be less stable over an
entire career than a primary specialty. Therefore, we cannot assume that
the settings of medical practices of the younger physicians necessarily
reflect current or future trends in medicine. They may only indicate the
type of practices younger physicians have. As physicians age, changes may
be made, so that their practices resemble more closely those of older
physicians .

Tables 9 and 10 indicate that both younger men and younger women are
less likely to have office-based practices than the older physicians.
Younger women are more likely than younger men to have hospital-based practices
and less likely to have "other" practices. Younger male physicians are
slightly more likely than younger female physicians to have hospital-based
practices and less likely to be inactive. However, the proportion of women
who are inactive is fairly substantial for all age categories. This may be
due to family responsibilities coupled with lack of part time job possibilities,
Both younger groups have large proportions of physicians who are "not
classified".
Summary

The important finding in this research is that changes in the proportions
of women and men in medicine may not alter substantially the distribution of
primary specialties and the settings of medical practice in the State of
North Carolina. Important changes in the profile of one state's physician
population seem to be the result of trends among younger physicians -- both
male and female.

Figure 4: Setting of Medical Practice of all Physicians, 1973, and Projected Distribution if 20%
were women and 80% men, omitting interns and residents

80

70

60

50

40

30

20

10

72.9

office
based

5.6

M

hospital
based

10.6113

other

8.3

inactive

4.5 4.6

not
classified

1973

projected

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Footnotes

Statistical Abstract of the United States, 1970, U. S. Department
of Commerce, Bureau of the Census, Washington, D. C. : U. S. Government
Printing Office, p. 65.

^Resources for Medical Research Report, No. 13, June 1968, Special
Report on Women and Graduate Study, U. S. Department of Health, Education
and Welfare, National Institutes of Health, p. 7.

3Dube, W. F. "Women Students in U. S. Medical Schools: Past and
Present Trends." Journal of Medical Education, 48 (February 1973):
186-189.

The setting of medical practice is called by the American Medical
Association, the type of medical practice. Examples of settings of
medical practice are: office-based practice; hosp.ital-based practice,
medical teaching.

^Data is from the American Medical Association.

^This is what is happening at the University of North Carolina
School of Medicine.

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